Overview
Care Clusters are a powerful way to improve targeting and improve upon one-dimensional "number of services" per code. Care Clusters capture scenarios involving multiple codes, intersection and exclusivity of codes, as well as more advanced business rules.
Here are some examples of what Care Clusters can do:
- Break down a code into its component procedure types
- Count instances where multiple codes (either of the same or different types) occurred together on a single claim
- Understand reimbursement impact for special scenarios where codes receive an adjusted reimbursement when paired together
- Differentiate a code based on the billing setting in which it occurred (i.e. office vs facility, or outpatient vs inpatient)
- Combine codes (either of the same or different types) into a single count
- Count service lines where a specific diagnosis was used
- Report on the utilization of a "procedure" across care settings ("knee replacements" combining inpatient, outpatient, and ASC settings)